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Nebraska
NEBRASKA
Nebraska is one of two states in which statutory obstacles to full nurse-midwifery practice still remain. At this time, there are no CMNs practicing in Nebraska, except on a US Air Force base. The political saga to expand nursing practice in Nebraska started in 1975 when the Nebraska legislature empowered the Board of Nursing to collaborate with the Medical Board to set rules for Advanced Registered Nurse Practitioners (ARNPs). About two years later, the two boards had agreed on rules for ARNPs, but the state’s Attorney General voided the rules, saying that the nursing statute did not adequately cover such expanded roles. So in 1978, the Nebraska Nurses’ Association sued the state to force promulgation of the rules. However, they lost the case when the judge ruled that the Nurses’ Association was not the proper plaintiff. Finally in 1981, six years after the initial authorization, the legislature passed new legislation called the Practice of Nursing in Expanded Roles Act. However, the new legislation does not permit the Board of Nursing to define categories of nurse practitioners. Instead, every classification of nurse practitioner must be specifically approved through legislation following the format approved in the 1981 law. So far, only the nurse anesthetists have gotten a law passed legalizing their practice. A nurse-midwifery bill has not yet been attempted. The 1981 Nurse Practitioner format requires completion of an advanced course of study with a minimum length of nine months or one academic year in an accredited program. Certification as a nurse practitioner is awarded by the Depart-
Journal of Nurse-Midwifery Cmwiaht
??
ment of Health with approval of the Board of Nursing and the Board of Medical Examiners. A personal interview may be required at the discretion of the Board. An advisory council of three nurse practitioners in the specialty and one MD is appointed to advise the Board of Nursing. A nurse practitioner can practice within a “statutorily established accepted scope of professional practice of the particular specialty area.” Independent practice is prohibited. The other problem for CNMs in Nebraska is that the Medical Practice Act specifically cites obstetrics as the practice of medicine. Although there have been no formal opinions on the issue, the general consensus in the state is that anyone other than a physician who attends a birth is liable for practicing medicine without a license under current laws. There is an active consumer group called Nebraskans for Certified Nurse-Midwives, which has been lobbying the legislature. In August 1983, they sponsored a very successful public hearing through the Public Health and Welfare committee. Their address is Nebraskans for CNMs, c/o Lincoln-Lancaster Commission on the Status of Women, 901 P Street, Lincoln NE 68508. They plan to sponsor a CNM Practice Act in the State legislature in the 1984 session. Medicaid and private insurance reimbursement are moot issues at this time.
Are CNMs practicing in the jurisdiction: No Authorizing law: None Regulated by: See text
Vol. 29. No. 2, March/April 1984
0 1984 by the American College of Nurse-Midwives
Form of legal authorization to practice: RN license Frequency of renewal of legal authorization: Unknown CNM named in statute: No
CNM named in regulations: No ACNM certification recognized: No RN license required: Yes Written evidence of collaboration agreement required: Unknown Prescriptive authority: No Can CNMs sign birth certificates: Yes Third-party reimbursement dated: No Medicaid reimbursement known
man-
status: Lln-
Can graduate nurse-midwives practice before ACNM certification: Unknown CEUs required for CNM: No CEUs required for RN: Yes
ADDRESS OF REGULATORY AGENCY
Board of Nursing 301 Centennial Mall South PO Box 95065 Lincoln, NE 68509 ADDRESS OF MEDICAID OFFICE
Department of Public Welfare 301 Centennial Mall South Lincoln, NE 68509 ESSENTIAL LEGAL CITATIONS
Practice statute: Nurse Practitioner Format, Revised Statutes of Nebraska, Section 71-1704 et seq.; Nurse Practice Act, Revised Statutes of Nebraska, Section 711132.01 et seq.
117 0091-2182/84/$03.00
Practice regulations: Nebraska Administrative Rules and Regulations, Nursing Rule 63 Medical practice act: Revised Statutes of Nebraska, Section 71-1102 et seq. Birth certificates: Revised Statues of Nebraska, Section 71-604
118
Journal of Nurse-Midwifery
?? Vol.
29, No. 2. March/April 1984
Nebraska is one of two states in which statutory obstacles to full nurse-midwifery practice still remain. At this time, there are no CMNs practicing in Nebraska, except on a US Air Force base. The political saga to expand nursing practice in Nebraska started in 1975 when the Nebraska legislature empowered the Board of Nursing to collaborate with the Medical Board to set rules for Advanced Registered Nurse Practitioners (ARNPs). About two years later, the two boards had agreed on rules for ARNPs, but the state’s Attorney General voided the rules, saying that the nursing statute did not adequately cover such expanded roles. So in 1978, the Nebraska Nurses’ Association sued the state to force promulgation of the rules. However, they lost the case when the judge ruled that the Nurses’ Association was not the proper plaintiff. Finally in 1981, six years after the initial authorization, the legislature passed new legislation called the Practice of Nursing in Expanded Roles Act. However, the new legislation does not permit the Board of Nursing to define categories of nurse practitioners. Instead, every classification of nurse practitioner must be specifically approved through legislation following the format approved in the 1981 law. So far, only the nurse anesthetists have gotten a law passed legalizing their practice. A nurse-midwifery bill has not yet been attempted. The 1981 Nurse Practitioner format requires completion of an advanced course of study with a minimum length of nine months or one academic year in an accredited program. Certification as a nurse practitioner is awarded by the Depart-
Journal of Nurse-Midwifery Cmwiaht
??
ment of Health with approval of the Board of Nursing and the Board of Medical Examiners. A personal interview may be required at the discretion of the Board. An advisory council of three nurse practitioners in the specialty and one MD is appointed to advise the Board of Nursing. A nurse practitioner can practice within a “statutorily established accepted scope of professional practice of the particular specialty area.” Independent practice is prohibited. The other problem for CNMs in Nebraska is that the Medical Practice Act specifically cites obstetrics as the practice of medicine. Although there have been no formal opinions on the issue, the general consensus in the state is that anyone other than a physician who attends a birth is liable for practicing medicine without a license under current laws. There is an active consumer group called Nebraskans for Certified Nurse-Midwives, which has been lobbying the legislature. In August 1983, they sponsored a very successful public hearing through the Public Health and Welfare committee. Their address is Nebraskans for CNMs, c/o Lincoln-Lancaster Commission on the Status of Women, 901 P Street, Lincoln NE 68508. They plan to sponsor a CNM Practice Act in the State legislature in the 1984 session. Medicaid and private insurance reimbursement are moot issues at this time.
Are CNMs practicing in the jurisdiction: No Authorizing law: None Regulated by: See text
Vol. 29. No. 2, March/April 1984
0 1984 by the American College of Nurse-Midwives
Form of legal authorization to practice: RN license Frequency of renewal of legal authorization: Unknown CNM named in statute: No
CNM named in regulations: No ACNM certification recognized: No RN license required: Yes Written evidence of collaboration agreement required: Unknown Prescriptive authority: No Can CNMs sign birth certificates: Yes Third-party reimbursement dated: No Medicaid reimbursement known
man-
status: Lln-
Can graduate nurse-midwives practice before ACNM certification: Unknown CEUs required for CNM: No CEUs required for RN: Yes
ADDRESS OF REGULATORY AGENCY
Board of Nursing 301 Centennial Mall South PO Box 95065 Lincoln, NE 68509 ADDRESS OF MEDICAID OFFICE
Department of Public Welfare 301 Centennial Mall South Lincoln, NE 68509 ESSENTIAL LEGAL CITATIONS
Practice statute: Nurse Practitioner Format, Revised Statutes of Nebraska, Section 71-1704 et seq.; Nurse Practice Act, Revised Statutes of Nebraska, Section 711132.01 et seq.
117 0091-2182/84/$03.00
Practice regulations: Nebraska Administrative Rules and Regulations, Nursing Rule 63 Medical practice act: Revised Statutes of Nebraska, Section 71-1102 et seq. Birth certificates: Revised Statues of Nebraska, Section 71-604
118
Journal of Nurse-Midwifery
?? Vol.
29, No. 2. March/April 1984